IDSA: Rapid HIV Test Tracks Infection in Jails

Action Points

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Publiic health officials should note that this study demonstrates that offering rapid HIV tests to all inmates increases acceptance of HIV testing and the number of HIV-infected persons identified.

VANCOUVER -- Even inmates who are short-timers in jails, for example, persons being held in municipal jails while awaiting trial, should be considered for HIV-testing using rapid testing technology, a researcher said here.

In three large jails -- where prisoners are typically kept only for a short time -- rapid HIV testing was offered to between 12% and 100% of inmates in a one year-period, according to Curt Beckwith, MD, PhD, of Brown University in Providence, R.I.

Of those, between 22% and 79% completed the testing and 142 new cases of HIV infection were diagnosed among the more than 41,000 prisoners tested, Beckwith said at the annual meeting of the Infectious Diseases Society of America.

The issue is important, Beckwith told reporters, because some 13 million people pass through jails in the U.S. every year, many of them at high risk for HIV infection but unlikely to get tested. Unlike prisons, he said, where organized healthcare, including HIV testing, is available, jails have typically not tested inmates for HIV.

But at jails in Baltimore, Philadelphia, and Washington programs to offer rapid tests to all inmates were successfully implemented in late 2008 and 2009, resulting in "really dramatic increases in testing," he said.

Among the results:

In Washington, an estimated 14% of inmates completed HIV testing before the program was introduced, compared with 79% in 2009.

In Philadelphia, about 10% of inmates had HIV testing before the program, compared with 69% in 2009.

And in Baltimore, about 0.4% of inmates completed testing before the rapid test program, compared with 22% in the period from May 2008 through April 2009.

The report here comes after CDC analysis reported earlier this year that reported similar successes in a Rhode Island jail. Beckwith was also part of that study.

Last June, the CDC reported that over an eight-year period rapid HIV testing in a centralized Rhode Island jail, conducted as a matter of routine, had identified 169 new cases of HIV.

Of those, the agency said, 72 were released within seven days and 42 within two days and could have been missed if the testing had been delayed.

The 169 jail house diagnoses represent 15% of all new HIV cases identified in Rhode Island during the same time period, the CDC said.

What was interesting about the study presented here was that it took place in jails rather than prisons, said Joel Gallant, MD, of Johns Hopkins University, who was not involved with the study but who moderated a press conference at which the data were discussed.

"Jails are short-stay sorts of places, where healthcare is often completely ignored," he told MedPage Today, while prisons usually have highly organized systems to get healthcare -- and access to HIV testing -- to inmates.

Gallant noted that the advent of new ways of testing for HIV was central to the study. "It's only rapid testing that allows that sort of thing to be done," he added.

The study was supported by the National Institute on Drug Abuse. Beckwith did not report any disclosures.

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